Provider Demographics
NPI:1740403799
Name:SEVERS, LISA (OTRL)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:SEVERS
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5619 DARLING ST. UNIT C
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007
Mailing Address - Country:US
Mailing Address - Phone:989-205-3450
Mailing Address - Fax:
Practice Address - Street 1:2665 ROYAL FOREST DR. SUITE B-90
Practice Address - Street 2:
Practice Address - City:KINGWOOD TX
Practice Address - State:TX
Practice Address - Zip Code:77339
Practice Address - Country:US
Practice Address - Phone:281-358-0577
Practice Address - Fax:281-358-1520
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201004942225X00000X
FLOT 10487225XP0200X
TX117705225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL889306300Medicaid